A federal judge threw out a nursing home staffing mandate enacted by the Biden Administration. Oklahoma providers argued it asked them to find staff they couldn't afford and that doesn’t exist.
The final rule required the following:
- Facilities must provide a minimum total of 3.48 hours of direct nursing care per resident, per day.
- The 3.48 requirement must include .55 hours of care from a registered nurse (RN) per resident, per day and 2.45 hours from a nurse aide per resident, per day.
- Facilities must have a registered nurse on site 24/7.
An analysis found the rule would require Oklahoma to hire over 1,200 full-time employees, including 538 nurse aides and 715 RNs over the five years the rule was phased in. It would cost Oklahoma nursing homes an estimated $76 million per year. Oklahoma ranks 46th in the U.S. for nurses per capita.
Gov. Kevin Stitt signed a letter to the Biden administration, alongside 14 Republican governors, urging it to reconsider the mandate. Other officials, like Lt. Gov. Matt Pinnell and U.S. Sen. James Lankford (R-Okla.), have also opposed the mandate and its particular threat to rural nursing homes.
The American Health Care Association filed a lawsuit challenging the rule last year. U.S. District Court for Northern Texas Judge Matthew Kacsmaryk ruled in the plaintiffs’ favor this week. He said regulatory responses must be consistent with Congress’s legislation, and provisions of the mandate that were challenged in the lawsuit are not.
Congress, for example, set the baseline at eight hours a day for RNs.
“Though rooted in laudable goals, the Final Rule still must be consistent with Congress’s statutes,” the court document states. “To allow otherwise permits agencies to amend statutes though they lack legislative power. Separation of powers demands more than praiseworthy intent.”
It's unclear whether the Trump administration plans to appeal.
President and CEO Steve Buck of Care Providers Oklahoma, which represents a portion of the state’s nearly 300 nursing homes, said the decision is a “great relief.”
“The threat of this mandate has caused a lot of undue stress on caregivers – health care heroes – who are at the front line providing care, who work diligently to do that every day,” Buck said. “They have been living with the pressure of thinking that they were going to have to hire new staff that candidly weren't in the pool, and they're going to have to hire them with money that wasn't available.”
Buck said he encourages Congress to codify this decision in federal law. He also said Care Providers Oklahoma will continue advocacy on closing the gap in Medicaid reimbursement and the cost of care for state nursing homes. A recent rate increase helped lessen it, but Oklahoma Health Care Authority (OHCA) data estimates that gap to be about $33 per resident, per day.
Beyond that, Buck said he wants to have conversations on how to maximize care for seniors. One point of interest, he said, is a bill from Rep. Trey Caldwell (R-Faxon), which would create a grant program within OHCA to promote collaboration between nursing facilities and public school districts. It’s called the Intergenerational Education Program.
“It allows seniors to interact with young people and, conversely, young people to interact with seniors,” Buck said. “That's a community good. That goes beyond just the provision of health care.”
Buck said the court’s decision allows nursing homes to have an “important reset.”
“Credit to the men and women who are working on the front lines every single day,” Buck said. “They were heroic during COVID, they kept showing up, they kept providing care, and they continue to do some really remarkable things in the community.”
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